Neuendorff Nina Rosa, Boshikova Boryana, Frankenstein Lutz, Kirchner Marietta, Rohde Christian, Goldschmidt Hartmut, Frey Norbert, Müller-Tidow Carsten, Jordan Karin, Sauer Sandra, Janssen Maike
Department of Medicine V-Hematology, Oncology and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany.
Department of Hematology and Stem-Cell Transplantation, University Hospital Essen, Essen, Germany.
Front Oncol. 2023 Apr 27;13:1168120. doi: 10.3389/fonc.2023.1168120. eCollection 2023.
In patients with cardiovascular (CV) comorbidities that necessitate antiplatelet therapy (APT), its optimal management during chemotherapy-induced thrombocytopenia remains elusive, as the risk of bleeding has to be balanced against the risk of CV events. The purpose of this study was to assess the risk for bleeding with APT during thrombocytopenia in patients with multiple myeloma undergoing high-dose chemotherapy and subsequent autologous stem-cell transplantation (ASCT) with and without acetylsalicylic acid (ASA) as comedication.
We assessed patients who underwent ASCT at the Heidelberg University Hospital between 2011 and 2020 for bleeding events, management strategies for ASA intake during thrombocytopenia, transfusion requirements, and the occurrence of CV events.
There were 57/1,113 patients who continued ASA until at least 1 day after ASCT; thus, a continuous platelet inhibition during thrombocytopenia was assumed. Most of the patients (41/57) continued ASA until they had a platelet count of 20-50/nl. This range reflects the kinetics of thrombocytopenia and nondaily measurements of platelets during ASCT. A tendency toward a higher risk for bleeding events in the ASA group was demonstrated (1.9% (control group) . 5.3% (ASA), p = 0.082). The risk factors for bleeding in multivariate analysis were the duration of thrombocytopenia < 50/nl, a history of gastrointestinal bleeding, and diarrhea. The factors predicting the duration of thrombocytopenia were age >60 years, a hematopoietic stem-cell transplantation comorbidity index ≥3, and an impaired bone marrow reserve at admission. CV events occurred in three patients; none of them took ASA or had an indication for APT.
The intake of ASA until thrombocytopenia with a platelet count of 20-50/nl appears safe, although an elevated risk cannot be excluded. If ASA is indicated for the secondary prevention of CV events, the evaluation of risk factors for bleeding and a prolonged time of thrombocytopenia before conditioning is crucial to adapt the strategy for ASA intake during thrombocytopenia.
在患有需要抗血小板治疗（APT）的心血管（CV）合并症的患者中，化疗诱导的血小板减少期间其最佳管理仍不明确，因为出血风险必须与CV事件风险相平衡。本研究的目的是评估在接受大剂量化疗及随后自体干细胞移植（ASCT）的多发性骨髓瘤患者中，血小板减少期间使用APT并联合或不联合乙酰水杨酸（ASA）作为辅助用药时的出血风险。
我们评估了2011年至2020年间在海德堡大学医院接受ASCT的患者的出血事件、血小板减少期间ASA摄入的管理策略、输血需求以及CV事件的发生情况。
57/1113例患者持续服用ASA直至ASCT后至少1天；因此，假定血小板减少期间存在持续的血小板抑制。大多数患者（41/57）持续服用ASA直至血小板计数为20 - 50/μl。该范围反映了血小板减少的动力学以及ASCT期间血小板的非每日测量情况。ASA组出血事件风险有升高趋势（1.9%（对照组）对5.3%（ASA组），p = 0.082）。多因素分析中出血的危险因素为血小板减少持续时间<50/μl、胃肠道出血史和腹泻。预测血小板减少持续时间的因素为年龄>60岁、造血干细胞移植合并症指数≥3以及入院时骨髓储备受损。3例患者发生CV事件；他们均未服用ASA或有APT指征。
在血小板计数为20 - 50/μl的血小板减少期间服用ASA似乎是安全的，尽管不能排除风险升高。如果ASA用于CV事件的二级预防，评估出血危险因素以及预处理前血小板减少的延长时间对于调整血小板减少期间ASA摄入策略至关重要。
